Topical Issue Debate

Employment Support Services

Deputy Olivia Mitchell

I appreciate the opportunity to raise the issue of genuine confusion about eligibility for JobBridge. I refer, specifically, to the eligibility of young graduates.

JobBridge is acknowledged to be an excellent scheme and an ideal opportunity, in a recession, for young people to be eased into the workforce. However, it seems that a large cohort of young graduates are ineligible to participate. I speak about graduates who are living at home, largely because they have no jobs, and because they are assessed on family income, they are not eligible for jobseeker's allowance which, in turn, prohibits them from participating in the graduate scheme.

In a recent reply to a parliamentary question, the Minister informed me that signing on for credits would entitle a graduate to participate after the requisite 78 days. My concern is twofold. First, a graduate who is ineligible for jobseeker's allowance and who has never paid a PRSI contribution — has never had a job — cannot sign on for credits and is, therefore, ineligible to participate in the scheme. Second, there is a lack of clarity regarding those who have paid PRSI, perhaps as part of a summer job, and their eligibility. The Department's website says one is eligible if one has paid a contribution in the last two years. Someone in the Minister's Department told me one is eligible if one has ever paid a PRSI contribution. Several cases have come to my attention of graduates who have worked and paid contributions but have been told they are ineligible for JobBridge. There seems to be inconsistency in this regard.

I ask the Minister to clarify the rules that pertain in these cases and to ensure that all social welfare offices are clear about the criteria. My main concern is the graduates who are not in receipt of jobseeker's allowance and who have never worked. The rules are clear. They are precluded from the scheme. For them there is a vicious circle in that because they cannot get a job, they cannot sign on and because they cannot sign on, they cannot apply for JobBridge and are disadvantaged in the jobs market. Given that they are forced through unemployment to live at home and, therefore, be assessed on their parents' incomes, they will be precluded from the scheme forever. The Gradlink scheme, which was subsumed into JobBridge, was aimed, specifically, at this group and it seems unfair that they are precluded.

First, is it possible to relax the rules? I realise there are financial implications, but I am sure people who have no jobs and recognise that they are ineligible for jobseeker's allowance or benefit would be willing to participate in JobBridge, even for the top-up payment of €50. Second, can the Minister clarify the question of PRSI contributions? What is required in terms of the number and timing of contributions? Can those criteria be made absolutely clear to offices throughout the country?

Minister for Social Protection (Deputy Joan Burton)

I am delighted to have an opportunity to reply to the matter raised by Deputy Mitchell.

The JobBridge scheme is the Government's national internship scheme. It will provide up to 5,000 places for those seeking employment, with an internship opportunity of six to nine months in an organisation in the private, public or community and voluntary sectors. During this time participants will receive an allowance which will consist of a €50 per week top-up to their existing social welfare entitlements.

There are, currently, 2,500 internships advertised on the JobBridge website and just over 2,000 people have commenced an internship. That includes about 625 people who transferred from the FÁS work placement programme, where no top-up was paid. The rest are people who started with the JobBridge internship programme.

In order for an individual to be eligible to participate in JobBridge, the national internship scheme, an individual must be currently in receipt of a live claim, that is, jobseeker's allowance, jobseeker's benefit or signing for credit, on the live register and have been in receipt of jobseeker's benefit, jobseeker's allowance or signing on for social insurance contribution credits for a total of 78 days or more in the last six months.

A recent graduate signing for credits will be eligible to participate in JobBridge 78 days from the day they first signed on. A person may qualify for credits if they have one paid contribution and do not have a two year gap in their social insurance record when they sign on. If the graduate has never worked, he or she is not eligible to participate in the scheme. However, graduates who are not eligible for JobBridge can avail of the work placement programme. Anyone who is unemployed is eligible to apply for the work placement programme. It is another work experience programme that allows graduates to continue to develop and improve their skills in a work environment.

The scheme has been extremely successful. It has been going for 16 weeks and we have more than 1,400 participants. It is not a graduate only scheme. There is no requirement that a participant would have graduated. It is, however, suitable for people who have completed a certain level of education or training. Some are graduates or, indeed, postgraduates. The scheme is proving extremely popular. Many employers have offered to take part and host internships.

I will bear in mind what the Deputy has said. The scheme came with conditionality in relation to taking people off the live register. That was one of the IMF conditions that we acceded to. I am conscious of the situation the Deputy describes. We are amending the scheme as we go along where we can get the agreement of the Department of Finance. It came with certain conditionality. However, there is a great deal of enthusiasm about the scheme. It is new to Ireland and we are listening very carefully to any criticisms that are offered. That is the experience of the host employers, of applicants and of those who have commenced internships.

Deputy Olivia Mitchell

I appreciate the Minister's response. There is a realisation that the group of people of whom I speak fall between all stools.

I am aware of the work placement programme but it is not geared toward graduates. There is a real need for graduate internships. Graduates, particularly in technical or scientific areas, de-skill very quickly if they do not get work opportunities. I am delighted the Minister recognises the need to be flexible and may respond in time to this group.

I take it that the requirement is that an applicant must have made a PRSI contribution in the previous two years.

Deputy Joan Burton

We are keeping the scheme under review. It has been extremely successful. We are limited overall to 5,000 places over a two year period but we will continue to examine the eligibility criteria. The scheme is a labour activation measure. We have agreed with the IMF that people who have been on the live register should be given encouragement options to go back to work or to take part in training. We have clarified that people who are coming directly from training courses can proceed to JobBridge. Last Friday, I was pleased to be involved with Skillnets when 25 people, principally engineers, had received training in areas such as medical devices and were about to participate in JobBridge.

There are many innovations in the scheme. I remain open to innovate further as the opportunity arises, subject of course to the agreement of my colleague, the Minister for Finance.

Alcohol Products Tax

Deputy Michael McNamara

I draw the attention of the House to the increase in off-licence sales and decrease in on-licence sales and to some of the consequences of this for the State. Official figures from the Revenue Commissioners suggest two thirds of beer purchased in Ireland is purchased in pubs, with one third being purchased in off-licences. However, industry sources suggest the figure for pubs is somewhat lower and for off-licences is higher.

Currently, there is a 5% per annum reduction in the amount of alcohol purchased in licensed premises. However, there is no such reduction in regard to alcohol purchased in off-licences. We will soon reach a situation whereby half of all alcohol purchased in Ireland will be from off-licences, rather than pubs as has been the tradition heretofore. This has a number of consequences for the State which are not good, the obvious one being a loss in revenue to the Exchequer. Even if the same amount of alcohol was being sold — it is not because there is a decrease in this regard — VAT is at 21%. Therefore if, for example, supermarkets sell beer at €1 per can as a loss leader, which they are and have been doing, the VAT to the Exchequer is relatively small. On the other hand, the VAT to the Exchequer from the purchase of alcohol from licensed premises at a considerably higher price is much greater.

Approximately 60,000 to 70,000 people are employed in the hospitality sector in Ireland, a great proportion of whom are in the pub business as compared with the off-licence sector which, I understand, employs approximately 4,000. A number of jobs are under threat because of the shift from the consumption of alcohol on licensed premises. Approximately five rural pubs are closing every week, with a resultant loss of employment. By and large, pubs are family businesses which employ people on a casual basis. In response to a question from Tourism Ireland brand tracker in regard to what people look forward to doing when visiting Ireland, 46% of visitors from France, 43% of visitors from the US and 40% of visitors from the UK said they looked forward to visiting an Irish pub. Unsurprisingly, no one looked forward to going to an Irish off-licence as it is hardly a unique experience.

I understand the next budget will not be a giveaway budget. It will on the contrary be a painful budget. However, I wonder if the move from consumption on licensed premises to off-licence sales could be addressed in the forthcoming budget, even if this means favouring the sale of alcohol, from an excise or tax perspective, in pubs, which are supervised environments. It is illegal to sell alcohol to a person who is intoxicated. However, people can purchase as much alcohol as they want from an off-licence. I believe many of the difficulties being experienced on our streets is the result of young people purchasing large amounts of alcohol in off-licences, drinking it at home and then going out onto the street. I ask the Minister to try to address this through taxation measures.

Minister for Finance (Deputy Michael Noonan)

I thank Deputy McNamara for raising this issue. The Revenue Commissioners is responsible for the collection of tax on alcohol products. Alcohol products tax is charged by reference to the nature of the product. The same rate of tax applies irrespective of the type of premises in which the product is sold. I am advised by the Revenue Commissioners that for this reason data are not available on the breakdown of alcohol products tax receipts between licensed premises and off-licences.

The basis on which alcohol products tax is charged means there is no loss in the yield from that tax to the Exchequer if a product is sold in an off-licence as opposed to a licensed premises. In fact, the lower prices typically associated with off-sales mean the tax incidence is higher in the case of such sales. The rate of VAT is also the same irrespective of where the alcohol is sold but the yield would be somewhat lower from the sale of a particular product when sold in an off-licence given the typically lower prices in that particular sales channel. However, the rate of VAT from any level of expenditure on alcohol is the same regardless of whether it takes place in an off-licence or a licensed premises.

Receipts from excise duties on alcohol products totalled €826 million in 2010, down from €968 million in 2009. Projected receipts for alcohol excise for 2011 are likely to show a slight increase over 2010. The excise duty on all alcohol products was decreased in budget 2010 by approximately 20%. Prior to this, excise duty on beer had remained unchanged since the budget of January 1994, apart from the introduction in October 2008 of a new 50% lower rate of excise for beers and cider of alcohol strength by volume of less than 2.8%. The duty on cider was increased in December 2001 and duty on spirits was increased in December 2002. Duty on wine was increased in October 2008 by 50 cent per standard 75cl bottle and pro rata increases were applied to related products. The Deputy should be aware that the decreases in 2010 applied across all areas regardless of where the products were consumed or sold.

It is accepted that there has been a general trend towards off-sales in recent years. High pub prices, price discounting in supermarkets, the smoking ban and the introduction of random breath testing for drivers have all contributed to this shift towards the off-trade. While this movement is excise-neutral there is a loss of VAT from sales at lower off-licence prices. A report on the Irish beer market in 2010 published by the Irish Brewers Association earlier this year indicated that in 2010 some 33.4% of beer was sold through the off-trade as compared with 28.9% in the previous year. This is in line with anecdotal evidence of a trend over time away from on-trade to off-trade.

Deputy Michael McNamara

I thank the Minister for his detailed response. The loss of VAT from sales at lower off-licence prices concerns me. Perhaps the Minister would consider addressing this issue, even if this means raising VAT on off-licence sales so as to ensure licensed premises are better able to compete. I understand there would be legal difficulties in doing so owing to European Union law. However, as I understand it Portugal applies a higher taxation level for alcohol sold in off-licences. Perhaps the Minister would consider introducing similar measures in Ireland to try to protect the few rural pubs remaining.

Deputy Michael Noonan

The same tax regimes applies in respect of alcohol products whether sold off-trade or on-trade. There is no variation in that regard. There would be no possibility of distinguishing for VAT purposes between off-licences and public houses. Pricing in respect of alcohol will be a key issue in the recommendations of the steering committee on substance misuse, which is expected to be published shortly. The recommendations contained in that report will form the basis for a Government action plan on alcohol due early next year. The Deputy could perhaps commence the debate here and continue it when the report is published. We might be able to make some progress by approaching it from a different direction.

General Practitioner Services

Deputy Charlie McConalogue

I thank the Ceann Comhairle for putting this matter on the agenda and ensuring it will be addressed by the Minister. This is a very important issue to County Donegal which has been leading to some concern among people over the past number of days. I have put this on the agenda to give the Minister for Health and his Department the opportunity to reassure people in County Donegal that there is no threat to the continuation of NoWDOC services at the four centres in County Donegal from which it is currently provided and that the service will be maintained at its current level, thus ensuring people have 24 hour access to a GP within a reasonable distance from their homes.

When people contact NoWDOC or a GP in the middle of the night or outside normal office hours, it is not because they have something wrong with them which can wait until the next day; it is because they have a concern in regard to their health that often is an emergency which needs to be addressed by a doctor immediately. There has been some concern, and much coverage in newspapers, in the past week in regard the potential closure of three of the outreach centres in the county, with the GP service from midnight to 8 a.m. being provided through Letterkenny alone. Indeed, there is a rumour that perhaps only one car will be provided.

As we can all understand, that is very concerning and it must be knocked on the head immediately by the Minister and the HSE so that we can all be sure that service will continue to be provided. We had a meeting last Friday, which all Oireachtas Members from the county attended, with HSE management and which was very useful. We made it very clear at that meeting that this issue must be addressed immediately. HSE management indicated that it does not have any plans to change the service but in written correspondence from the HSE, we have not received absolute clarity that is the position of the Department of Health and the HSE.

This is a red line issue and it is not up for negotiation. The Minister has the opportunity to reassure people and I ask that the Minister of State takes this opportunity to do so.

Minister of State at the Department of Health (Deputy Róisín Shortall)

I thank the Deputy for raising this issue. The provision of general practitioner, GP, out-of-hours co-operatives throughout the country is an essential part of our health service and we fully support that policy in terms of strengthening primary care services and ensuring that, as far as possible, care needs are met in the primary care setting. Out-of-hours co-operatives are now in place in all HSE areas, providing coverage in all or in part of all counties. The service can be accessed through a single lo-call telephone number in each region and caters for both public and private patients.

Out-of-hours co-operatives allow GPs to manage the provision of urgently needed care for their patients while their surgeries are closed in the evenings, at weekends and on public holidays. The co-ops also afford GPs reasonable off-duty arrangements. Under the GMS contract, GPs have a responsibility to enable contact to be made with them, or a locum, for emergencies outside normal practice hours. It is a matter for the GPs how they arrange this cover.

The NoWDOC service, which is now ten years in existence, is a co-operative structure between GPs and the Health Service Executive to provide urgent GP services to patients who may require them in the out-of-hours periods, that is, evenings, nights and weekends. It covers Donegal, south Leitrim and north Roscommon, with 98 full-time GPs participating in the service. The budget for the NoWDOC service last year was €3.168 million, while the national budget for GP out-of-hours services last year was almost €100 million. More than 57,000 people contacted the NoWDOC GP out-of-hours service last year and, of these, more than 36,000 were treated at the GP out-of-hours treatment centre or received a home visit. Some 33,600 people contacted the NoWDOC service in the first six months of this year.

In terms of the partnership that exists between the GPs and the HSE, the HSE provides the infrastructure for the service, including support staff, such as drivers, receptionists, nursing staff and so on. The GPs provide the cover for the various doctor rotas for the out-of-hours periods. All calls to the service are handled and triaged in the call centre in Letterkenny and treatment centre visits are arranged by appointment only.

The HSE west is currently reviewing the NoWDOC services. This follows directly from the recommendations of the national review of GP out-of-hours services which was carried out and published in 2010. The HSE, in implementing the recommendations of the national review, is looking at all operational activity, including staff who are employed by the HSE, to ensure that safe and efficient services can be maintained in the current difficult financial environment. This review to date has resulted in the HSE submitting proposals to the trade unions regarding the redeployment of receptionist staff and the expansion of the drivers' role under the provisions of the public service agreement 2010-2014. These discussions are ongoing and will be concluded in the coming weeks.

The proposed changes reflect the staffing models that operate elsewhere throughout the country and will provide for the continuity of safe patient care at each of the centres which are affected in this proposal, that is, Derrybeg, Carndonagh, Mountcharles and Carrick-on-Shannon.

At the annual general meeting of NoWDOC Limited, the GP members of NoWDOC passed a motion to form a sub-committee to examine viable options for the provision of GP cover for red eye periods and submit proposals to the HSE to outline how such cover might be provided more efficiently without compromising patient safety.

The outcome of the GPs review has not yet been finalised and no proposals have been submitted to the HSE for consideration. While changes to service delivery arrangements may be proposed in the future, the issue of curtailing or reducing services has not featured in any discussions to date. Again, I thank the Deputy for raising this matter.

Acting Chairman (Deputy Peter Mathews)

I must confess to my unfamiliarity with the term "NoWDOC".

Deputy Charlie McConalogue

I thank the Minister of State for her reply. I note she said that no changes are proposed to service delivery arrangements. That, in itself, is welcome. However, it is important that it is made absolutely clear to the Department of Health and the HSE, in the future and in these more difficult financial times, that the provision of GP services at centres, which are local to people throughout County Donegal and the rest of the country, are a red line issue and not up for negotiation. No one has any problem with GPs and the HSE talking to each other. However, the key point which has not been made clearly enough today or by the HSE is that from a Department of Health and a HSE point of view the continuation of GP services in a local area and within a reasonable distance from people's homes is absolutely critical and will be at the core of any discussions so that people can be assured there is no threat to local GP out-of-hours services, whether red eye or pre-midnight services. That is critical and I ask the Minister of State to be clear in that assurance.

Will the Minister of State comment on the current restriction that applies to NoWDOC cars in that they are restricted to the speed limits even when they are on emergency calls? This does not make sense. Many roads in County Donegal have 80 km/h speed limits because they are not national roads. Only a few weeks ago, a GP car responding to a call in the Carndonagh area was fined and received two penalty points. That needs to be addressed. If someone in County Donegal or elsewhere is waiting on an emergency GP service, one does not want that GP stuck doing 30 mph within a 30 mph zone or 80 km/h within a 80 km/h. One wants the GP to put on the emergency lights and get to the patient as quickly and as safely as possible. Will the Minister of State assure the House that people will continue to have access to GP services within their local areas?

Deputy Róisín Shortall

I assure the Deputy that the Government is committed to the development of primary care services and GP care throughout the country. This is one reason for the clear commitment in the programme for Government to provide for free GP care during the Government's lifetime. It is also one of the reasons we will start debating a Bill this evening on opening up access to the General Medical Services, GMS, scheme. I am working on expanding the number of GP training places, as we want 90% of health care activity to occur at primary care level. During the coming months and years, we will roll out reforms to enable this health activity to take place as close as possible to patients, which is where people want to be treated. It makes sense.

Ensuring access to out-of-hours GP care is part and parcel of the reforms, as it makes sense from the patients' point of view to deal with people's conditions early and before they become serious enough to warrant a trip to hospital. This approach also takes pressure off the hospitals. We will discuss this point during Private Members' business.

I pay tribute to the work of NoWDOC in providing a range of services in the north west during the past ten years. However, it is the contractual responsibility of GPs to ensure out-of-hours cover is provided. While the HSE provides the infrastructure and support services, for example, receptionists, drivers and so on, it is primarily the responsibility of the GPs to ensure that they adhere to the terms of their contracts. The HSE is waiting for the proposals to be returned by the GPs involved to determine the arrangements it will make to ensure the existing cover in the north west is maintained.

I am not in a position to respond on the issue of speed limits, but I will take it on board and determine what can be done.

Accident and Emergency Services

Deputy Gerry Adams

Tá mé fíor-bhuíoch don Cheann Comhairle as ucht seans a thabhairt dom labhairt ar an ábhar dáiríre seo. Cé go bhfuil áthas orm go bhfuil an tAire Stáit anseo linn, tá mé míshásta nach bhfuil an tAire, an Teachta Reilly, i láthair. Is ceist an-tábhachtach í ceist na ndaoine le TB.

This morning, I visited Our Lady of Lourdes Hospital in Drogheda. I visited it several times in recent months and witnessed many patients, some of whom were elderly, lying on hospital trolleys or sitting on chairs or the floors while waiting to be treated by an overstretched and overworked medical staff. Níl a fhios ag na hothair seo cathain a bhfeicfidh siad dochtúir, nó an mbeidh leapacha cearta acu. Tá an córas slándála atá againn sa tír seo ar nós córas sa Tríú Domhan.

Last Friday, it was revealed that a patient who had been on a trolley in the emergency department for five days had TB.

(Interruptions).

Deputy Gerry Adams

I do not want to cut across the Minister of State and Deputy Ciarán Lynch. Gabh mo leithscéal — tá mé ag caint faoi rud an-tábhachtach. Three other patients and an undisclosed number of staff are being screened for this dangerous disease.

The deterioration in the hospital's situation is not unexpected. Bhí mé ag tabhairt amach anseo faoi sin. Chuir mé eolas faoin slí criticiúil ina bhfuil saoránaigh sna otharlanna seo roimh an Aire agus an Taoiseach. Three weeks ago, Deputy Tóibín, Dr. Rory O'Hanlon and I wrote to the Health Information and Quality Authority, HIQA, to ask it to launch a full public investigation of the hospital's emergency department urgently and immediately and to publish the findings. We did so because Drogheda has consistently ranked as the hospital with the worst waiting list in the State. For months, the number of patients on trolleys at the hospital has consistently exceeded 30, resulting in significant pressure on the emergency department. This represents a clear threat to patient safety and welfare. Management at the hospital has responded by putting into effect the full capacity protocol, which means that it identifies spaces in wards in which to place patients even though the wards may not be appropriate to the patients' health needs.

HIQA declined to order an investigation. In light of the TB case and the ongoing crisis in the emergency department, I am calling on HIQA to reverse its decision. I am disappointed that the Minister for Health is not present, although I am grateful that the Minister of State is substituting for him. If HIQA continues to refuse to order an investigation, the responsibility for doing so falls to the Minister. I am calling upon him to do it.

Deputy Róisín Shortall

I thank Deputy Adams for raising this issue. The Minister, Deputy Reilly, is not in a position to take the debate, but I will do so on his behalf.

The incident raised by the Deputy related to a patient who presented to the emergency department of Our Lady of Lourdes Hospital with symptoms unrelated to TB. In all, the patient spent five days in the emergency department. During his time there, he was given a chest X-ray and was found to have TB. Following the discovery of TB, appropriate isolation and treatment commenced.

During the period that the patient spent in the emergency department, three patients were identified as potentially having had contact with him for more than ten hours. They have been contacted, counselled and offered testing for TB. All staff with potential contact have been offered counselling and TB testing. Our Lady of Lourdes Hospital has reassured the public about the incident, saying that contact had been made with the patients involved. The HSE is satisfied that the incident has been appropriately handled from the points of view of infection control and contact tracing.

While it is important that any public concern be allayed, I will address the wider issue of emergency department waiting times. The Minister does not consider it acceptable that a patient should wait five days. To tackle unacceptably long waiting times in emergency departments, he set about establishing the special delivery unit, SDU, immediately following his appointment. Its aim is to unblock access to acute services by improving the flow of patients through the system. The SDU is focusing initially on emergency departments and will be working to support hospitals in addressing excessive waiting times for admission to hospital.

Deputy Gerry Adams

I have a great deal of sympathy for the Minister of State, who has probably been handed a script to read out, but her reply was unsatisfactory. She did not mention that the patient was on a trolley for five days. Instead, she stated: "In all, the patient spent five days in the emergency department" and the Minister "does not consider it acceptable that a patient should wait five days". Today is Tuesday. The Minister of State should imagine being restricted to a trolley, even in the best of health, until Sunday. Her reply is not worth the paper on which it is written. Will there be an inquiry? Were we advised of measures that will be put in place to discover how this situation occurred?

In its five point plan the Fine Gael Party pledged to reform the health service and cut waiting lists, but it is prepared to perpetuate the mess initiated by Fianna Fáil and the Progressive Democrats. Today there are 344 patients on trolleys across this State and 28 of these are in Drogheda. The waiting list for hospital treatment has increased by 40% since the start of this year.

The health service is not being properly funded. That is obvious to the professionals — I met with the management briefly today — and to the patients. The Government says the money is not there but that is not true. Politics is about choice and everybody present in this Chamber knows that. The Government is making political choices. A political choice was made to read a script such as the one the Minister of State read. It contains a big lie in that it omits the fact that this person was on a trolley. A political choice will be made on 2 November to give €700 million of the people's money to unguaranteed banks. The Government is making a political choice in paying off unguaranteed bondholders instead of fixing the health service. That is not acceptable and I do not mean this personally in terms of the Minister of State, but tá a lán rudaí mícheart leis na rudaí anseo. There are many things wrong but this is one issue and one problem which can be fixed.

There is a hospital up the road from Drogheda that has a 23-bed ward which is closed. Across that region there are 62 patients, mostly elderly people, who have already been medically discharged but have nowhere to go because of the mess in regard to the fair deal scheme.

This matter needs to be resolved. With all the fine rhetoric that sometimes flows about citizens' rights, the republic and so on, when it comes down to it if one is lying on a trolley in a hospital corridor and contracts TB, that is how one measures one's republic.

Deputy Róisín Shortall

When I responded to the Deputy's matter, I told him the factual position. The patient concerned was in an emergency department for five days and during that period was discovered to have TB. The appropriate action was taken at that point in terms of isolation and treatment.

I said at the end of my reply that the fact that anybody is on a trolley for five days is not acceptable. That is why this Government is setting about introducing fundamental reforms to the health service. It is an absolute priority of both parties in government to bring about that reform. They are the political choices that this Government is making. We are setting about a root and branch reform of the health service and considerable work has been done to date. It is one of the reasons we are committed to introducing a single tier health system because it is not a question of tinkering at the edges with the existing health system. The issues are much more complex than simply being about funding. The whole system needs to be changed and we are determined to do that. That is set out clearly in the programme for Government which commits to introducing a single tier health system based on providing care on the basis of a person's need rather than on his or her ability to pay. That will happen as soon as possible. We are introducing an insurance-based health system. We are doing that as soon as possible and in the short term we are introducing significant reforms in the primary care area.

In addition to that, very soon after being appointed, the Minister established the special delivery unit, SDU, whose job is to act as a hit squad, as it were, to target those hospitals where there are difficulties, where systems are not properly functioning, to enable them to deal with the kinds of demands that they have. That work by the SDU is well under way. It has examined a number of hospitals and identified 15 that provide unscheduled care and those hospitals that need urgent support from the SDU. Among those hospitals are eight that currently account for approximately 60% of the trolley count. Our Lady of Lourdes Hospital is one of those eight hospitals. Those hospitals have been identified as needing urgent and high level support from the SDU. The eight hospitals have recently been asked for proposals setting out measures that could be taken quickly in the hospital and-or in a closely related community setting which would significantly relieve pressure on the emergency department by, for example, addressing delayed discharges and having step-down beds. Proposals relating to seven of the hospitals or associated community services have just been received and will need to be given very detailed consideration by the SDU. These proposals from the seven hospitals include proposals from Our Lady of Lourdes Hospital and the SDU is examining those urgently with a view to implementing them very quickly.

A good deal of action is being taken. The Government is committed to longer-term reform and that work is well under way and in the shorter term the SDU is addressing the current logjams that exist in many of our hospital emergency departments. The proposals have just been received from Our Lady of Lourdes Hospital and they will be responded to very quickly. I thank the Deputy for raising this issue.

Dáil Éireann díospóireacht - Tuesday, 25 Oct 2011